Orthognathic Surgery: Preparation and Follow-up

Author: Assoc. Prof. Dr. Halise Aydemir, Orthodontic Specialist.

Orthognathic surgery involves joint planning by an orthodontist and a maxillofacial surgeon, usually followed by orthodontic preparation, surgery and recovery, then final orthodontic adjustments and retention. For skeletal discrepancies in jaw position, the goals may address facial balance alongside chewing, the bite and speech. Not every jaw discrepancy requires surgery; suitability depends on an individual examination and appropriate records. The sequence, duration and follow-up plan also depend on that assessment.

What stages does the orthognathic surgery process consist of?

The first step is for the orthodontist and the oral and maxillofacial surgeon to evaluate the treatment goals together. Whether surgery is needed is a separate decision, explained in the guide to surgical suitability. If the surgical option is chosen, the general flow goes like this:

1. Joint plan: The goals for the teeth, jaws and bite, the necessary records and the limits of the options are explained.
2. Orthodontic preparation: Teeth can be prepared according to the planned new jaw relationship. At this stage, existing bite discrepancy may temporarily appear more noticeable.
3. Surgery and recovery: The surgical team gives personal instructions regarding the procedure, hospital, nutrition, medication and early check-ups.
4. Orthodontic follow-up and retention: Final bite details are monitored, and a plan is made to maintain tooth positions.

The duration and order of the stages vary from person to person. Find out in your written plan which team will answer which question and how to reach out in case of an unexpected situation. AAO patient information also describes joint planning and orthodontic preparation.

What goals are clarified in the first meeting?

The orthognathic surgery process does not start only with the day of surgery. The orthodontist evaluates the bite of the teeth and the relationship of the jaws; the oral surgeon explains possible surgical movements and general suitability for surgery. The patient's complaints about chewing, speaking or facial balance are listened to separately. It is not correct to make a preparation plan without determining which finding is related to tooth movement and which is related to jaw position.

Ask for the expected changes to be explained in writing or visually at the first consultation, but do not consider the simulation as a guarantee of final results. The treatment goal should include how the bite will be before and after surgery. If you are still considering whether surgery is needed, start with the article on suitability assessment; this page focuses on the stages of treatment.

What duties do the orthodontist and oral surgeon undertake in the process?

In orthognathic surgery, the preparation of the teeth and the positioning of the jaws should be linked to a single goal. Instead of the orthodontist and surgeon making independent plans, how the teeth will meet after surgery and what change is intended are evaluated together. The patient's expectations are also included in this common goal.

The orthodontist aims to harmonize the alignment of the teeth and their root positions with the surgical plan, and then arrange the bite details. The maxillofacial surgeon evaluates bone movement, surgical risks, hospital and recovery process. General health and anesthesia suitability are handled by the relevant teams. Referrals to other specialties vary according to clinical need.

Stage	Main question	Coordination issue
Joint initial plan	Which problem arises from the teeth and which from the jaw relationship?	Explanation of goals and alternatives together
Orthodontic preparation	How will the teeth close in the new jaw position?	Evaluation of tooth position before surgery
Surgical preparation and procedure	What bone movement and what risks are involved?	Records, hospital, anesthesia and surgical instructions
Early recovery	Is recovery progressing as expected?	Compatibility of surgical care and orthodontic devices
Final orthodontics and retention	Have the bite and retention goals been achieved?	Follow-up of dental contacts and retainer plan

This table is not a mandatory appointment schedule for a particular clinic; it shows why the tasks are interconnected. Mayo Clinic description explains the planning of surgery and orthodontics together and the role of records.

The patient should know who to call at each stage. There should be clear contact details for the surgical team about wounds, bleeding or recovery, and for the orthodontist about appliances and the bite. In an emergency, do not wait only for a reply to a routine message.

If the treatment goals change, the team should explain what this means for the remaining stages. For example, further tooth movement before surgery may affect the operation date. Understanding why a plan has changed helps you prepare more realistically than relying on a fixed schedule.

How are planning and records used?

Photographs, intraoral impressions or scans and necessary radiographic records can be examined for the relationship between teeth and jaw. Which records to obtain depends on the individual clinical question. The orthodontist evaluates how the teeth will close in the planned jaw position after surgery, and the surgeon evaluates the limits of bone movement. Thus, a surgery plan is not made based on facial appearance alone.

The length of orthodontic preparation varies between patients, so a fixed schedule cannot be promised. AAO information on surgical orthodontics also states that preparation often begins before surgery.

Why is orthodontic preparation necessary and why might the bite look bad temporarily?

The purpose of pre-surgical orthodontic preparation is for the teeth to meet properly in the planned new jaw position. Initially, the teeth may be at inclinations that partially compensate for the existing jaw difference. Correcting these inclinations may make the actual disharmony of the jaws more obvious for a while. For this reason, the current bite appearance and the target after surgery are not the same stage.

For example, if the lower and upper front teeth are tilted to cover the jaw difference, trying to reduce the visible front tooth distance alone may conflict with the surgical goal. In preparation, the position of the teeth on their jawbones is arranged; during the surgical phase, the jaws are brought into their new relationship. This explains why a patient may ask: “Why does my bite look worse now that I have braces?”

BOS information on orthognathic treatment clearly states that the bite may look worse before surgery. However, not every change is automatically considered normal. A new problem must be separated from the planned temporary change; the patient should be informed in advance about the expected changes in appearance and function.

Preparation includes monitoring:

• Alignment of teeth and necessary space arrangement
• Root positions and boundaries of teeth within bone support
• Compatibility of the upper and lower tooth rows with the planned jaw relationship
• Hygiene, gum health and appliance integrity
• Current records required for the surgical plan

Hypothetical example: Increasing the distance between the front teeth in preparation may be part of an initially stated goal of compensation removal. A completely different tooth movement may have been planned for another patient who sees the same image. Therefore, a decision cannot be made whether "it's going right" or "it's going wrong" by comparing photos.

The end of preparation is not determined only by the number of months that have passed. It is jointly evaluated whether the teeth are in the appropriate position for the surgical plan. Selected patients may follow a different sequence; surgery cannot be assumed to come first or later for everyone. The personal phase order and possible changes should be explained by the team.

What should you expect during surgery and early recovery?

Orthognathic surgery is a procedure planned under hospital and anesthesia conditions; the jaw or jaws treated and the extent of surgery vary between patients. Conditions such as swelling, discomfort, nutritional restriction or change in sensation may occur after surgery. Their degree and course depend on the procedure performed and personal circumstances. Another patient's recovery video does not replace a personal calendar.

At the surgical consultation, the team should explain possible risks alongside expected benefits. Mayo Clinic discusses risks such as bleeding, infection, nerve damage and changes in sensation, bite problems, relapse of jaw position, or the need for further procedures. This list does not mean that everyone is at the same risk level; the surgeon evaluates which risks apply to your surgery and how.

Everyday consideration	Individual instructions to obtain beforehand
Nutrition	Which consistencies are appropriate when and how to ensure adequate nutrition
Oral hygiene	How to clean the wound and appliance area
Medication	How to take prescribed medicines and whom to contact about problems
Activity	Return conditions for school, work, exercise and travel
Check-ups	How surgical and orthodontic follow-up will continue
Unexpected symptoms	When to seek urgent care and which team to contact

It is important to receive written instructions and contact details prior to discharge. Do not change your elastic arrangement, add medicines or advance your diet based on online advice; follow your own team’s instructions. Returning to work does not mean bone healing is complete; activity restrictions may still apply even if you feel well.

Acute, significant breathing difficulty or uncontrolled bleeding requires emergency medical care rather than waiting for a routine check-up. The personal instructions should also identify any other symptoms the team specifically asks you to report.

Surgery may not be the last day of the orthodontic process. With recovery, final arrangements of dental contacts and preservation of the result are planned. The overall process should be understood as separate stages: preparation, surgical recovery, final orthodontics and retention. Rather than promising a fixed hospital stay or return to school day, the personal criteria for these stages should be explained.

What should you ask about plates, screws and sensation changes?

Small plates and screws may secure the jawbones in their new position. The surgeon decides whether later removal is needed; there is no universal removal date. Nerve injury and sensation changes belong in the surgical risk discussion. Do not assume numbness is necessarily temporary or will resolve by a particular month; report new or persistent changes to the surgical team. The Mayo Clinic guide explains fixation components and nerve injury risk.

Why does orthodontic follow-up continue after surgery?

The healing period managed by the surgical team and orthodontic follow-up are different tasks. The orthodontist monitors tooth contacts and, if necessary, minor tooth movements in the new position of the jaws; surgery itself does not automatically complete all the details of the bite. When treatment is finished, the option of fixed or removable retention is determined according to the individual plan.

Clarify in the discharge and follow-up instructions which symptoms should be reported to the surgical team, and which bite or appliance problems should be reported to the orthodontist. Do not copy review frequency or retainer use from another patient's plan.

What is discussed during the examination?

• Chewing, speaking, joint complaints and aesthetic expectations
• Alignment of teeth, relationship between bite and jaw bones
• Photographs, intraoral scans and necessary radiographic records
• Limits of non-surgical orthodontic options
• Stages of joint treatment, need for follow-up and possible risks

Frequently asked questions about the process

Does preoperative orthodontic treatment last the same for every patient?

No. The extent of preparation varies depending on the initial position of the teeth and the planned jaw movement; another patient's calendar is not a personal time estimate.

Does orthodontics end immediately after surgery?

Follow-up usually continues for the final bite details and the retention plan. The orthodontist and surgical team explain the personal review schedule.

Is it possible to prepare for surgery with a clear aligner?

Different orthodontic systems can be evaluated in selected cases; the appropriate method is planned according to the shared treatment goal.

Note: This content is for general information. The eligibility decision requires personal examination and joint evaluation of relevant experts. For more detail, see the orthognathic surgery service page.

Source

American Association of Orthodontists: Orthodontic surgery process

Related reading

• Who may be considered for orthognathic surgery?
• Orthognathic surgical treatment approach